Targeted Probe and Educate (TPE) Reviews

These are another form of Medicare claims data-driven reviews done by your Medicare Administrative Contractor (MAC).

This FAQ addresses the following:

1. What are Targeted Probe and Educate reviews?
2. Why are these reviews being implemented now?
3. How many charts might this entail?
4. Why are there three rounds of TPE review?
5. How do the MACs choose what issues on claims get a review?
6. How is the decision on whether subsequent reviews happen take place?
7. What sort of education is provided if I don’t do well after a round?
8. What resources does CMS provide on TPE?
9. What happens if I don’t do well on round 3 of TPE?
10. How should I protect myself from a TPE review?

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